REPUBLIC OF THE PHILIPPINES)

C I T Y O F M A K A T I ) S.S.

AFFIDAVIT OF LOSS

I, RICHARD C. RAMISO, of legal age, Filipino citizen, with residence address at

Barangay Mamplasan, Biñ an, Laguna, Philippines, after having duly sworn to in accordance
with the law do hereby depose and state, that:

I am a holder and possessor of ATM Card issued by ChinaBank;

The discovery in the loss of aforesaid item has been established, thus far due to
circumstances beyond knowledge; whereof, assuming that the same was misplaced and
could no longer be found;

Diligent effort has been made but futile; therefore considered it lost for all intents
and purposes;

I am executing this affidavit to attest to the truth of foregoing facts, for information
and guidance of proper authorities concern and for whatever legal purpose this affidavit
may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto set my hand on this 19 th day of August 2022, in

the City of Makati.

RICHARD C. RAMISO
Affiant

SUBSCRIBED AND SWORN to before me on this 19 th day of August 2022, in the City
of Makati. Affiant exhibited to me his Pag-Ibig Loyalty Card with number 1212-4761-9131.

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